Pain Management in Australia

[SKR]

In most pain cases for long term opiates to be RXd you have to see a PM first, since you're already on opiates for pain I don't know what else a PM can do for you besides recommend some Physio, hydrotherapy etc. maybe surgical intervention or spinal injections and adjuvant medications. Some people get taken off meds, others get dosage reviews. Mine had never even heard of DHC so you probably will already know more about what works for your pain than they will.

They will likely put together a medication plan to follow which will be sent to your doc and then you'll get a permit for your scheduled meds if you don't already have one. At this point you will follow up with your GP and then have to visit every month to follow up on your conidition and to receive your meds.

I wasn't put through too many hoops in this particular case since I had already been through PM clinics in the past and trialled all the non narcotics and other BS therapies over the years before I decided to go on regular medication. I had a pretty bad injury with scans to back up the validity of my condition. so no psychologists or drug tests in my case although if you have a history of drug use or a vague condition like fibromyalgia this might be a condition.

It's a catch 22 but I can honestly say it's better to have the pain than be chained to opiates indefinitely.

Thank you for sharing what you can ODB, I appreciate you taking the time to do so. I expect all of the above as my GP has pretty much put me through the same routine of specialists and physicians before I was ever considered a candidate for strong opiates. And yes being addicted to this shit makes me as anxious as the pain does and frankly I wish I had been strong enough to put up with it...but being told I am likely going to develop and die of myeloma by my haematologist knocked the wind out of me - I couldn't handle the physical pain anymore. And perhaps my GP knows that at some stage they are going to be throwing opiates at me (Until I ultimately stop breathing) as myeloma is basically untreatable and 100% fatal - it may not have been such a hard decision for her to prescribe me oxycodone etc.

Well another round of injections into a nerve and facet joint yesterday have not yielded a positive result so far but I understand I still may get some relief from the cortico steroid through its anti-inflammatory action but we'll see. The anaesthetic wasn't even as good as the first round of injections I had 6 months ago, at least that time I had significantly reduced pain for 24hours. The issue is no one has been able to identify the problem sufficiently enough to treat it - it fucking sucks that I can wake up one day and have such pain that just will not ease. I simply slept on my side on a couch so deeply that I did not move or adjust my position for 6-7 hrs and whammo - nerve damage.

The appointment with the psychologist is a requirement for everyone who goes through the pain management clinic I've been referred to. I'll post after the appointment and let you all know why it was included.

Yeah for sure Six, makes sense that any doctor will need to assess a patients mental state before proceeding with any treatment. My mental state became poor due to my pain, and it's fair to say my other health problems haven't helped. I also lost $50,000 these last 12months through an investment. I'm fighting to get it back but at some point the lawyers fees out way the money owed and I don't have the strength to worry about principles...Erg, what the hell happened to me?!

Anyway, keep us posted Six and I'll do the same as I progress through the same system and hopefully we can create an information hub for others who may be facing the same shit, thanks again.

 

[brighton]

Isn't much of an OP (Original Post?)? I'm probably better off UTSE on the net to see if clinics put up the sort of information I'm looking for I suppose.

So Sublimit, if you have had some experience you can probably tell me if you were required to submit blood and urine samples as part of your agreement?
What was the experience with the clinic like generally? Did you find a resolution to whatever issue you presented with?

I can't really add anymore detail as such as I am simply asking whether anyone here has or is going through the Pain management system.

Ive been to one pain management doctor and one pm clinic in New Zealand. Its pretty much the same country as Asstralia right?
The private pm doctor was ok - Started me on dhc, tramadol and gabapentin, 3 month prescriptions, no urine or blood tests or contract but he was a robot. Zero emotion / empathy and he refused to prescribe anything stronger when i genuinely needed it. The meds helped somewhat.

The PM clinic at the public hospital was disgusting. They didn't believe in prescribing opiates or even acupan (nefopam), Im not kidding, I saw both doctors there and they both told me how current research shows opiates actually make the pain worse. But I wonder if that was because I was a young male with no clear diagnosis. No blood or urine tests or contract.
Luckily I got my GP to prescribe for a while but eventually he decided to agree with the clinic and taper me off. The psychologist there was an idiot whose first comment to me was - You're depression is causing you're pain. Really? So its not the nerve damage? Their physiotherapist was a joke. Physical therapy was apparently pointless as too much time has elapsed since my injury (2 years) so she wanted to do goal setting and lifestyle modifications. I only ever saw each of these people once and I found a real physiotherapist and she helped greatly to reduce my pain and increase my strength.

 

[brighton]

That doesn't match my experience at all. My experience was a lot of GP's telling me to take panadol and 'you're young, it'll go away, you'll be fine.'(I am, but it didn't and I wasn't)............................
..........Anyway, I know that's just one person's experience, maybe I just happened across the half dozen shittiest doctors (and single best psychiatrist) in the city by some really fucked up turn of chance. I don't know, but I think it's unlikely, especially from what I've heard from other people.

That sounds very similar to what I've been thru

 

[Crankinit]

I'm not disagreeing with your general narrative of how bullshit the system is (and your story aligns with that of a few people I know who have disclosed self-medication while seeking treatment for chronic pain) but this bit doesn't match up with my experience. It took me 1.5 years to get a fibromyalgia diagnosis, following testing for a textbook-filling range of other conditions and finally a referral to a rheumatologist. I haven't been prescribed anything for the pain so far (opiate or otherwise) and, as mentioned above, I've sat out a waiting list for pain management that's taken over a month (with zero pharmacological pain relief).

I'm younger than the usual age window that people develop fibro in, but not by a shocking amount.

I'm sorry to hear that - obviously I'm speaking in general terms, I know there are people of all genders/ages who have trouble with the (seriously fucked up) system, but it does tend to bias especially against the young and the penis-possessing I think it's a mix of the idea (which in fairness, I believe stats back up) that young men are the most likely segment of the population to use drugs (although that doesn't make us any less prone to pain) and in general the ingrained cultural concepts guys are supposed to "toughen up" while women need to be coddled, which to me seems to manage to be insulting to both genders...

thanks for sharing crankinit, nice to read your journey with pain and its solution, i'm looking to study tai chi or chi kung, but i have doubts it is taught in SA other than by teachers who do it as a physical exercise for relaxation rather than the deeper energetic level that i'm interested in.

Hey mate, I'm in SA as well, feel free to PM me if you want me to let you know what/where worked for me.

 

[ashstorm]

Wow, my gp is awesome compared to the hell you guys have had to go through..

Presented with thoracic pain in January, straight onto 10mg targin, followed by endone (which I hated, and requested to go back on targin), back on 10mg targin and lyrica (had a mild allergic reaction), tried endep (suicidal thoughts) and then doc also added 5mg targin.

I'm waiting to get the cash together for an orthopaedic surgeon to find out why I'm in such pain, which is difficult when you can't work and your partner earns too much for centerlink..

26 year old female, minor bone spurs and degeneration on t10/t11..

No visible track marks and my doc has no idea of my past heroin and meth addictions..

Also I only ever use my drugs as prescribed.. I don't find opiates enjoyable they're just a necessity for the low level of function I currently have.

 

[Crankinit]

Wow, my gp is awesome compared to the hell you guys have had to go through..

Presented with thoracic pain in January, straight onto 10mg targin, followed by endone (which I hated, and requested to go back on targin), back on 10mg targin and lyrica (had a mild allergic reaction), tried endep (suicidal thoughts) and then doc also added 5mg targin.

I'm waiting to get the cash together for an orthopaedic surgeon to find out why I'm in such pain, which is difficult when you can't work and your partner earns too much for centerlink..

26 year old female, minor bone spurs and degeneration on t10/t11..

No visible track marks and my doc has no idea of my past heroin and meth addictions..

Also I only ever use my drugs as prescribed.. I don't find opiates enjoyable they're just a necessity for the low level of function I currently have.

Then why the trackmarks from your "past heroin... addiction"? Not judging, just curious. Did you only use the H to come down from the Meth? Did you just lose your taste for opiates?

 

[ashstorm]

I just lost my taste for opiates, in early 2008.. Found it boring.

Moved into the rave scene, loved my pills and acid and moved into meth eventually.

Very rarely do anything these days.

 

[SixBuckets]

I'm sorry to hear that - obviously I'm speaking in general terms, I know there are people of all genders/ages who have trouble with the (seriously fucked up) system, but it does tend to bias especially against the young and the penis-possessing I think it's a mix of the idea (which in fairness, I believe stats back up) that young men are the most likely segment of the population to use drugs (although that doesn't make us any less prone to pain) and in general the ingrained cultural concepts guys are supposed to "toughen up" while women need to be coddled, which to me seems to manage to be insulting to both genders...

I guess there's an intersecting "thing" here - I have bipolar as well, and more than one doctor has expressed that they don't want to take responsibility for putting me on "more" medication. I guess I'm supposed to just tough it out and be happy that my bipolar is well controlled, or something?

It's a known thing amongst people with psych conditions that we just don't get appropriate medical treatment from anyone other than our brain doctors.

 

[Crankinit]

I guess there's an intersecting "thing" here - I have bipolar as well, and more than one doctor has expressed that they don't want to take responsibility for putting me on "more" medication. I guess I'm supposed to just tough it out and be happy that my bipolar is well controlled, or something?

It's a known thing amongst people with psych conditions that we just don't get appropriate medical treatment from anyone other than our brain doctors.

Honestly some doctors are just plain lazy. Why go to the trouble of taking on complicated patients who require more effort when they don't pay any more than the simple ones who can be handed a script and sent on their way?

 

[SixBuckets]

honestly some doctors are just plain lazy. Why go to the trouble of taking on complicated patients who require more effort when they don't pay any more than the simple ones who can be handed a script and sent on their way?

qft.

 

[SixBuckets]

My induction into the pain management clinic was yesterday.

It was basically a full day of presentations by different staff on the pain management team. There was some really good stuff (such as information about how chronic pain works and what happens in your body when you experience it) some sobering but useful stuff (such as a really honest and realistic Q&A about what we can expect from their pharmacotherapy team) some stuff about chronic disease self management and pacing and realistic expectations of life with pain (this was all really basic for me, as I've lived with other chronic illness for a long time, but useful to other people in the group) and some kinda hippie woo stuff about talk therapy and mindfulness and guided meditation (which I didn't think was useful to me at all). Generally a positive experience and I'm glad I went. I feel like I now have more knowledge to approach supporting therapies like appropriately managed exercise and physio and massage and stuff like that.

It was really good to have confirmed that the 'boom and bust' approach is a common and normal thing - I've been overdoing it on my 'good days' and ending up in bed for three days. They gave us some strategies to avoid this and manage our lives without unnecessary flare ups.

Now I have to wait until the end of the month until my first 1 to 1 with an actual clinician.

 

[Crankinit]

and some kinda hippie woo stuff about talk therapy and mindfulness and guided meditation (which I didn't think was useful to me at all).

You might want to read some of the studies about the benefits of that "hippie woo stuff" before you write it off. Just a thought, but it's good your first session seemed to go well.

 

[brighton]

I guess there's an intersecting "thing" here - I have bipolar as well, and more than one doctor has expressed that they don't want to take responsibility for putting me on "more" medication. I guess I'm supposed to just tough it out and be happy that my bipolar is well controlled, or something?

It's a known thing amongst people with psych conditions that we just don't get appropriate medical treatment from anyone other than our brain doctors.

Totally. After my pain meds got cut off and my pain blamed on my bipolar I was continually referred from shrink to shrink seeing none of them and getting no help whatsoever.

I ended up picking my own meds (suboxone and zyban) which are amazing

 

[SixBuckets]

You might want to read some of the studies about the benefits of that "hippie woo stuff" before you write it off. Just a thought, but it's good your first session seemed to go well.

I've read quite a lot about it. I've tried a huge range of meditation techniques in the last 15 years, and yes I gave them all "a good go". It's just not for me.

I also think things like mindfulness and meditation would be a lot more useful and accessible to more people if they were presented without the hippie woo.

And yeah, it did! I'm pretty pleased with the team.

 

[SKR]

My induction into the pain management clinic was yesterday.

It was basically a full day of presentations by different staff on the pain management team. There was some really good stuff (such as information about how chronic pain works and what happens in your body when you experience it) some sobering but useful stuff (such as a really honest and realistic Q&A about what we can expect from their pharmacotherapy team) some stuff about chronic disease self management and pacing and realistic expectations of life with pain (this was all really basic for me, as I've lived with other chronic illness for a long time, but useful to other people in the group) and some kinda hippie woo stuff about talk therapy and mindfulness and guided meditation (which I didn't think was useful to me at all). Generally a positive experience and I'm glad I went. I feel like I now have more knowledge to approach supporting therapies like appropriately managed exercise and physio and massage and stuff like that.

It was really good to have confirmed that the 'boom and bust' approach is a common and normal thing - I've been overdoing it on my 'good days' and ending up in bed for three days. They gave us some strategies to avoid this and manage our lives without unnecessary flare ups.

Now I have to wait until the end of the month until my first 1 to 1 with an actual clinician.

That's great, Thank you for sharing your experience Six, I appreciate you taking the time to do so.

 

[ashstorm]

After the easter weekend I let my supply of targin run rather short and actually ran out the day I was due to be able to get more.

Long story short, the payroll was late and I had to go 24 hours without any targin.

Boy, I had really forgotten how terrible withdrawal was, I'd buried it under memories of coming off antidepressants.. That was the most miserable evening and the following morning not only in pain but in physical withdrawal from the targin..

Not making that mistake again..

 

[SKR]

Hmm yes very unpleasant, bloody withdrawal. I haven't gone longer than 19 hrs without an oxy dose in about a year. I'm only just getting the runny nose and restless hands/legs at that mark. I'm dreading the almighty flogging I'm going to get when I have to come off. The thought causes me great anxiety.

 

[Runtoparadise]

I've posted in other threads about my pain management experiences, first time here.

I have musculoskeletal & neuropathic pain. Started with Gabapentin, then after a year of saying I'd leave ketamine infusions as my last option,- I caved & begged to be hospitalised for any type of pain relief after a month of central sensitisation.

I've now had fourteen infusions, & have decided to now work with a psychologist as spending so much time in hospital is not an option.

I'm seeing my third pain specialist,- in the same private clinic...they just seem to run out of ideas!!

I've had facet join injections, SI joint block, medial branch block, trigger pt injections, it's been endless. My last pain dr made me "earn my stripes", to stay on my dose of opiates.

The pains got me feeling pretty messed up atm, so the newest dr referred me on to learn some pain management strategies.

No tests, no contracts, but scripts strictly from the same GP & pharmacy.

Rtp

 

[SKR]

Thanks for sharing RTP and I'm sorry to hear about your pain issues. How long have you had your condition?

Being a chronic pain sufferer really sucks, I had no idea what it was like until I became one. I've handled various pains and things over the years much like any human really, mostly small injuries muscular, joint and connective tissue things related to training and engaging in various sporting disciplines but pain that never leaves you, and the only fluctuations are from bad to worse back to bad again are just mentally destructive. Nightmares, depression, anxiety.....just wanting someone to dig the fucking pain out of my back with a knife. I'm exhausted. Treating my body with hit and miss (mostly miss) drugs like a lab rat.

 

[Runtoparadise]

^Yeah, it blows at times. I've had chronic pain for almost ten years now, & on opioid therapy the whole time.

To the extent now that I an insane tolerance to opiates, which has in & of itself has created a dual problem. I'm prescribed a dose strong enough to kill a horse, & my pain mgmnt has reached a point where they're past their upper prescribing level & comfort zone.

Like plenty of other BLs, I take more than prescribed, for pain, & have periods constantly & consistently where I run short. I've written plenty before, but I'll say it again, my secondary issue is that each time I run out, obviously I go into wd. I cushion this ok with lyrica, but it's not a great situation.

Just a warning to others to try everything before opiates. My pain is very difficult to treat, hence the ketamine infusions.

SKR, what is the origin of your pain? What meds have you trialled so far?


Rtp